Written by Danielle Amos

On May 20th, 2025, Texas Representative Jodey C. Arrington introduced the “One Big Beautiful Bill Act” to the U.S. House of Representatives. This bill was formed around the agenda of Donald Trump’s second term as President of the United States of America. While it is framed as an effort to reduce government spending, its prospective impacts entail $1 trillion in funding cuts to healthcare programs, which would cause millions of Americans to lose their health insurance. Both low-income and rural communities will be negatively affected by this. Some changes have already begun because of the passing of the bill, therefore making it a public law. This law will only further exacerbate the healthcare inequity crisis in the United States.

Medicaid is a government program that provides health insurance for low-income Americans.

The $1 trillion in funding cuts to healthcare programs also includes Medicaid, which is set to lose $900 billion in funding. A month before the bill was signed into law, Medicaid covered 70.5 million people. The Congressional Budget Office estimates that 7.5 million people will lose their health insurance by 2034, due to Medicaid cuts. The Center of Budget and Policy Priorities, estimates that between 9.9 million and 14.9 million people are at risk of losing Medicaid coverage in the same time frame. The Medicaid cuts stem from three different parts of the bill: new work requirements, more frequent eligibility checks, and immigration restrictions.  The new work requirements will require recipients of Medicaid to work, or participate in qualifying activities, for 80 hours each month to remain eligible. This actually causes more harm than good, as it not only reduces access to healthcare but also increases the burdens and costs on the state. Prior to the passing of the “One Big Beautiful Bill,” most state laws required rechecking individuals’ eligibility every 12 months, but now, the law requires all states to check eligibility every 6 months. This change in frequency can lead to an increased risk of coverage loss, even when the person is still qualified to receive health insurance, which is called “coverage churning”. Coverage churning can be caused by various factors, like income fluctuations, changes in family circumstances, administrative errors, and inability to complete the reapplication deadline. Since these checks would happen more frequently, it would cause more of a strain on both Medicaid recipients and the workers completing these checks. Whilst undocumented immigrants have never been eligible to receive benefits from government-funded programs like Medicaid, documented immigrants will be restricted from receiving Medicaid if they are green card holders, are Cuban-Haitian entrants, or are people living in the United States under a Compact of Free Association. Due to these factors, 1.4 million immigrants are estimated to lose their health insurance.

Another part of the law that will negatively affect low-income communities is the reduction of the Supplemental Nutrition Assistance Program, or SNAP. Formally referred to as food stamps, SNAP provides grocery assistance to low-income individuals by granting its recipients a monthly budget to spend on food. Not only will families lose their health insurance because of this law, but they will also have a harder time getting groceries. In November 2025, a glimpse into the loss of SNAP benefits was seen, as a result of the 43 day government shutdown. One in eight Americans are enrolled in SNAP, largely from people residing in low-income areas. Sara Bleich, a professor at the Harvard T.H. Chan School of Public Health, stated, “There is strong evidence that SNAP lifts families out of poverty, reduces food insecurity, and lowers health care costs.” The legislation is set to reduce SNAP funding by $186 billion over the next ten years. Similar to the Medicaid effects, SNAP will now require its eligible members who are 18 years old to 54 years old to work 80 hours per month. Unstable work hours, veteran status, and homelessness are just a few reasons this new requirement negatively impacts society, as there are many variables that can risk the loss of SNAP benefits for hundreds of thousands of families across the United States. This law will only increase poverty and food insecurity among individuals, which will therefore negatively affect their health as well. A study found that food insecurity can cause an increased risk of obesity, as well as higher rates of chronic diseases. Food insecurity for children can cause developmental issues and mental health problems. 

The “One Big Beautiful Bill” will not just stop at targeting low-income communities; it is set to hurt rural communities as well. 20% of Americans live in rural regions. Because of their already limited medical care resources, they are disproportionately at risk for heart disease, obesity, and high blood pressure when compared to Americans residing in non-rural parts of the United States. 16.1 million people occupying rural communities are covered by Medicaid. Due to the future of Medicaid, fewer people in these regions will be covered by health insurance, therefore causing hospitals to lose additional funding that they need to stay open. 48% of rural hospitals were already struggling before the law passed, and, over the past 10 years, 92 rural hospitals have shut down due to financial strain. This will not only cause the rural communities to have reduced medical care opportunities, but it will also cause hundreds of people to become unemployed. In June 2025, multiple Democratic senators sent a letter to President Donald Trump, Speaker Mike Johnson, and Leader John Thune detailing the risks for rural hospitals if the “One Big Beautiful Bill” passed. Stated in their letter was every hospital across the United States that will be jeopardized by this law. Nearly 300 rural hospitals are at risk, with some states, like Kentucky, having as many as 35 hospitals listed in the letter. 

In conclusion, the “One Big Beautiful Bill” represents a turning point in healthcare struggles across the United States, generally affecting low-income and rural communities. These conflicts will be heavily felt across the country in many ways. Reduction in Medicaid and SNAP benefits only sets back the progress that was made in the last few decades. Rural healthcare will be even harder to reach. This law does not fulfill the dire needs of millions of Americans. It can only hurt them. Too many people rely on these programs for survival, and without them, who knows what the outcome is.

Edited by Arushi Gupta